Provider Demographics
NPI:1326362641
Name:ROA, EDUARDO H (DDS)
Entity Type:Individual
Prefix:MR
First Name:EDUARDO
Middle Name:H
Last Name:ROA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1341 W ROBINHOOD DR
Mailing Address - Street 2:SUITE C-3
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-5515
Mailing Address - Country:US
Mailing Address - Phone:209-957-0765
Mailing Address - Fax:
Practice Address - Street 1:1341 W ROBINHOOD DR
Practice Address - Street 2:SUITE C-3
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-5515
Practice Address - Country:US
Practice Address - Phone:209-957-0765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-15
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58327122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist